CHARLES RIVER BRIDGES FALL OFF THE SCHEDULE: State Needs To Find Funds Without Skimping on Surrounding Improvements

April 7, 2014

While work on the Longfellow and Anderson bridges is moving forward, plans for repairing and upgrading the in-between River Street and Western Avenue bridges and the messed-up intersections leading to them on both sides of the Charles River have suddenly disappeared from MassDOT’s Accelerated Bridge Program (ABP) agenda.  The bridge’s structural deficiencies are still there as are the approach roads’ deficiencies (have you ever tried crossing as a pedestrian in any direction from the DoubleTree?).   MassDOT, DCR, consultants, advocates (including the efforts of LivableStreets Alliance’s “Better Bridges” campaign), legislators, and community members have spent years worth of time negotiating, adjusting, and finally agreeing on a plan that would be a huge improvement to both safety and functionality, including physically separated bicycle lanes (“cycle tracks”) and much improved pedestrian crossings especially on the Boston side.  Designs are complete, permits are obtained, and contracts are ready to go.  But another funding source has not yet been identified. And MassDOT has indicated that, because other projects in the area will cause traffic problems, construction would not be able to begin until after 2019 in any case.  Still, despite this worrisome setback, this may be an opportunity to make the plans even better.

The Advocates and Community members’ main focus was on insisting that the new bridge designs include safe and ample facilities for pedestrians and bicyclists as well as smoothing car travel AND that the project extend beyond the bridge edge to include the adjoining intersections and approach roads.  Prioritizing the surface-level layout was based on the need to fix problems in already existing facilities.  (Which makes one wonder what is being done with the bridges in other parts of the state where there are fewer or no advocates to push for more forward-thinking visions!)  However, the Charles River bridge agreements notably left out the idea of further improving non-motorized travel along the river by fixing the remaining seriously deteriorated sections of path along both sides of the river, as well as  creating underpasses at each of the bridges – the later an idea that the Charles River Conservancy (CRC) came to champion.  The CRC has commissioned technical studies and renderings showing that the underpasses are both technically feasible and would cost relatively little if done at the same time as the bridge repair work.


MassDOT’s original reason for not including the Underpasses was that the many permits needed – from the US Army Corp of Engineers, various Conservation Commissions, and (most problematically) the notoriously uncooperative Mass Historical (preservation) Commission – could not be secured in time for the Accelerated Bridge Project deadline of 2016.  Moving the River/Western bridge work out of the ABP removes that scheduling problem.

As part of the negotiations around the Charles River bridges, MassDOT did agree to not repair the bridges in ways that would make the future creation of underpasses impossible.  Unfortunately, MassDOT’s official explanation of why work on the River and Western bridges is being delayed claims that ensuring the possibility of an underpass on the Anderson Bridge – coupled with the need to not start on these two bridges until work on the Longfellow and Anderson is complete – is what pushed the completion date too far beyond the ABP 2016 deadline.

It’s likely that adjusting the Anderson plans did make things for complicated.  However, rumors are circulating that this is a face-saving obfuscation.  If MassDOT had started talking with the Anderson contractor earlier in the process there would have been plenty of time to incorporate the needed changes.  According to the rumors, the real reason for delay is that the Mass Historical Commission has insisted that the contractor use a particular type of old-fashion, hand-made brick – and that several (maybe as many as 4) efforts by the only company able to produce these replica artifacts have failed to produce bricks with both the needed appearance and strength for the job.  Rather than take on the Historical Commission’s contentious Executive Director and possibly her boss, Secretary of State Galvin, as well, MassDOT is using the underpasses as its covering story.

The worst scenario would be if MassDOT decides to fall back on its old plans to just do the minimal needed safety-related repairs on the bridges themselves.  This may prevent additional parts of the bridge facade falling into the water – a non-trivial accomplishment! – but won’t do anything to improve regional transportation.  Getting the Charles River bridge work back on track, with the inclusion of both the river-side paths and the underpasses, is what is needed – but making that happen will require a united effort of the broadest possible coalition of agency leaders, advocates, community members and elected officials.   Starting now.

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STEERING THE ORGANIZATION: Using Decision-Point Criteria to Achieve Goals

April 2, 2014

MassDOT is legitimately proud of its progressive policies about creating a sustainable, multi-modal transportation system.  But the transfer from policy to facts on the ground has been very uneven and incomplete.  This isn’t surprising:  as with many other endeavors, road construction is a complex and multi-player process with gridlock and human life at stake.  It’s not easy to turn a ship as big and disjointed as MassDOT with its highway-trained staff and its enormous web of highway-derived vendors.

Fortunately, there are three high-leverage points in the project process – for transportation and in every other field – that can help speed policy implementation and adherence:

– Project Selection (both internally at MassDOT and through the MPO funding process),

– Project Design (particularly as summarized in MassDOT’s Design Criteria Workbook and Design Exception Report Guidance, which are themselves based on the new Healthy Transportation Policy Directive and the implementing E-14-001 – Design Criteria for MassDOT Highway Division Projects Engineering Directive);

– Project Evaluation (as captured in the new Planning For Performance  system and the Draft Transportation Impact Assessment proposal).

Ideally, the same high-level criteria should govern each of these decision-making events, even if there is a slightly different emphasis for each.  And, ideally, those criteria should have the same hierarchy:

* starting with the user experience of the problem (or need) being addressed and the proposed (or completed) solution…including both current users and potential future ones, both “in-vehicle” people and those living/working/traveling near the vehicles; then

* checking to what degree the proposed (or completed) project moves our transportation system towards key state and MassDOT policy goals; then

* noting how well the proposed (or complete) project meets (or exceeded) MassDOT’s and FHWA’s technical criteria, including whether it meet “desired” targets rather than “minimal acceptable” one; and finally

* how well the project meets budget and scheduling requirements (or expectations).

The list of Alternative Performance Measures in NACTO’s (National Association of City Transportation Officials) Urban Street Design Guide has some good initial suggestions, but we need to go further.   MassDOT deserves enormous credit for beginning to develop criteria for the three high-leverage decision points,  but it’s not clear that the agency sees them as a unified whole – there are three separate groups and processes dealing with each one.  What’s needed are a single set of easy-to-understand metrics, not some complex (even if perfectly tuned) methodology.  Coming up with a coherent, start to finish set of progressive criteria will not only be good for Massachusetts but might set the framework for a national effort to go beyond the car-centric and skimpy criteria being proposed for the federal MAP-21 Transportation program.

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MASS PIKE EXITS: Master Key for Unlocking Boston Roads from Esplanade to Allston

March 25, 2014

In real life there are no magic wands whose waving causes all problems to disappear, no magic pill that makes everything better.   But sometimes there are Master Keys that open a series of blockages and create new routes forward.  Even in transportation.  One possible Master Key is finding  ways to install new on/off ramps on the Mass Pike Extension from Allston to Mass Ave.

Right now, MassDOT planners are struggling with how to design the quarter-billion-dollar Mass Pike Re-alignment project at the Allston exit while maintaining (or expanding) the MBTA and Commuter Rail usage, with the final redesign of Cambridge Street from Harvard Ave to the Charles River, with the best way to fix the messed-up traffic on the Boston side of the BU bridge, with the appropriate design for Commonwealth Ave from the BU bridge to (and past) Packards Corner, and with what to do about the collapsing Fenway-to-Storrow Bowker Overpass (in addition to the path, initially proposed by the Solomon Foundation, from Beacon Street to the Mass Ave bridge)


At the same time, community and advocacy groups are pushing for pedestrian and bike routes that reconnect Allston Village (near the new Harvard Campus) with Comm Ave, and that run along the Grand Junction railway from Somerville through Cambridge over the RR bridge (under the BU bridge) to Allston.  Residents in the Charlesgate area are demanding that the Bowker be torn down and the area – an extension of the historic Emerald Necklace listed on the National Register of Historic Places as part of the Olmsted Park System – be rescued from the dominating concrete.  The Esplanade Association’s Vision 2020 is seeking to slow and reduce traffic on Storrow Drive in order to expand and protect that amazing parkland.  Last, but not least, the Red Sox and many Longwood Medical Area employers are desperately looking for ways to get their car-traveling patrons (and employees) more efficiently to and from their locations.

All these official and citizen efforts are finding their options relatively unsatisfying.  In almost every case, the amount of traffic that MassDOT (and sometimes Boston Transportation Department) planners anticipate requires dedicating so much space to cars that transit and non-motorized modes (and users) get short changed.  (It is likely that official projections of future car traffic are too high – there is a long national history of assuming more growth than has actually occurred.  But it will take years and enormous technical sophistication to revise current Projected Traffic Modeling software to incorporate contemporary trends of reduced car ownership and usage, increased transit and bike usage along with a huge and slowly emerging latent demand for walkable-bikeable-trainable communities.  In the meantime, we are stuck with overblown estimates that can limit and distort the available options.)


But here’s the amazing thing, the Master Key:  the options available in each of these situations would be radically expanded, and improved, if there were more and better off-on ramps for the Mass Pike Extension as it runs from downtown Boston to the Allston toll booths.  Not only would it move most traffic from Storrow to the Pike, it would make it easier to deal with the Allston toll plaza redesign and the other areas as well.

That’s a big claim, and there are so many intertwining components that our state’s Transportation Mage, Fred Salvucci, warns that it might be much smarter – and a lot more politically and financially realistic – to assume “that there will be no turnpike connections in this area in the short term…we might better place energy into getting public transportation means to attract people out of their cars.”


But the potential payoff of coming up with a good MassPike Extension On/Off Ramp solution is so large that it’s at least worth some out-of-the-box brainstorming.  And that’s what a bunch of people in the extended LivableStreets Alliance network have been doing for the best month or so.   Some of the ideas are straightforward; some are pretty imaginative.   But it’s likely that all are technically possible.  And all would both move car traffic more efficiently while creating room for pedestrians, bicyclists, and lots more parkland.   The bottom line, as usual, is money and political will – as well as a willingness to stretch the traditional envelope:  MassDOT has done its own studies of on-off ramp possibilities and has not yet come up with a workable option.

I do not intend to give a full description of all the ideas floating around – Frank O’Dette has put together an amazing You-Tube video that gives an easy to follow and visually understandable introduction to most of them.  Although the video revolves around ways to eliminate the Bowker it includes, by necessity, a creative look at ways to eliminate the traffic flow it now serves by opening additional MassPike Extension ramps.  He calls the video A Cure for B.O.? Fixing Boston’s Armpit: the Bowker Overpass which he describes as “a relic from the 60’s, stinking up the city.”  (If that link doesn’t work, or becomes inoperative due to future revisions, go to and search for “boston armpit” – which will bring you to the latest version.)


Here is a list of some the ideas that Frank summarizes:

  • Changing the Mass Ave. Pike on-ramp to an exit and moving the on-ramp further towards Allston;
  • Moving the shift in the RR tracks further out, creating space for an on-ramp from the Fenway;
  • Using part of the Pike breakdown lane for yet other potential on-off ramps;
  • Creating a more direct route from the Pike to the LMA;
  • Shifting a new Charlesgate-to-Fenway overpass to the side of the parkland;
  • Re-using existing pavement for new loops through the area to eliminate traffic light congestion;
  • Turning the road around the Fens into a one-way loop;
  • Building a Comm Ave bypass and Beacon Street diversion;
  • And much more…

Some of the ideas are relatively simple, some are very ambitious, and some are even further out.  But who knows – maybe it IS possible to create something that’s cheaper, safer, greener, more multimodal, and just as effective!


Thanks to Randall Albright, Parker James, and Frank O’Dette for all the work they’ve put into this effort; and to Ken Kruckemeyer, Peter Furth, Herb Nolan, Charlie Denison, and the other brainstorm contributors!


Some related previous posts:

> McGRATH HIGHWAY REPAIRS: The Occasional Superiority of Short-Term Solutions


> ALLSTON-BRIGHTON ON THE MOVE: Boston’s Most Transportation Changing Neighborhood

> NON-MOTORIZED HIGHWAYS: A Regional Green Routes System To Connect Municipal Bike Networks, Sidewalks, and Parks

> QUICK, VISIBLE, REMOVABLE: Improving City Life By Unleashing Citizen Creativity Through Government Initiative

>LEVERAGING PUBLIC SPENDING FOR MAXIMUM IMPACT: Do Multiple Goals Make Projects Better — or Unmanageable?




March 11, 2014

The Human Scale is a wonderful movie based on the powerful insights and work of progressive urban planner, Jan Gehl; it’s now available in CD format.  Everyone who loves cities should see it.  In potently visual scenes, the film lays out his critique of today’s automobile-focused high-rise urban design, the dangers of top-down authoritarian planning and “mega projects,” the value of allowing “ordinary” citizens to shape development goals, and the dynamism unleashed by embracing unplanned and open-ended grass-roots creativity.  It’s an important message from a brilliant person who carries forward the best of the Jane Jacobs and William Whyte tradition of human-centered city life.

But I left the theater extremely unsatisfied.  The movie presents all the evidence needed for a powerful conclusion, and goes as far as saying that “Master Plans” should be replaced with “Frameworks” that leave space for democratic uncertainty.  But it doesn’t really address the complexities of replacing central control with a free market of bottom-up innovation for entire cities or regions — how such an approach deals with planning for needed large-scale infrastructure for water or housing or energy or transportation that inevitably disrupts certain areas, or avoids simply turning planning over to the wealthy or ruthless, or deals with NIMBY parochialism or prejudice against various kinds of incoming “others.”

Maybe I’m jumping ahead of the movie’s own goals, however it seems to me that simply denouncing Le Corbusier and Robert Moses isn’t enough – we need to describe the alternatives.  And we have to admit that creating human scale environments requires not only a participatory, open-ended process but strong leadership as well as a large measure of good luck.

Neither top-down nor unregulated bottom-up: what cities need in order to make themselves livable is a sequence of interactive, tight-loose processes that move through the three phases of Planning, Design, and Implementation that combines broad participation with technical input, democratic debate with accountable central decision-making, long-term visioning of regional needs with sensitivity to particular circumstances, the vital role of strong leadership with the many benefits of distributed innovation, and a realistic understanding of financial realities with profit-making transparency.

Through all three phases, cities need a way to identify and prioritize needed infrastructure even if its construction will be disruptive; a way to mobilize the political momentum needed to push through often contradictory zoning, permitting, code, and regulatory requirements; and a willingness to accept that many end-stage details are simply not knowable at the start.

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PERFORMANCE MEASUREMENT FEEDBACK: It’s Hard to Stay on Route if You Don’t Know Where You’re Going

February 26, 2014

MassDOT deserves enormous credit for trying to connect its investment decisions with the desired outcomes.  It’s a challenging and complicated undertaking, constrained in many ways by federal reporting requirements, limited data, and unverified impact-calculating methodologies. The fact that their first attempt, the very impressive WeMove Massachusetts: Planning for Performance tool, is deeply flawed (for example, defining mobility solely as car travel) is much less important than the Agency’s public willingness to admit those flaws and commit itself to an iterative improvement process.  This is something that every public— and private – organization needs to take on, not merely to better serve its stakeholders but also to be better in control of its own fate.

When trying to make investments with impact, there are three major difficulties. First, you must identify and prioritize or “weight” the goals according to their relative importance, selecting carefully among possible Policy-based, User-Experience-based, and Operations-based goals.  For example, GreenDOT has declared “mode shift” to be a goal: to increase the number of people who choose to walk, bike or ride public transportation, instead of driving in a Single Occupancy Vehicle.  MassDOT also has a goal of keeping roads in a “state of good repair” – which may conflict with the mode shift goal by increasing the attractiveness of car driving relative to other modes.  Which goal gets higher priority?

Second is selecting the right metrics to evaluate progress towards each of the goals:  things that can be cost-effectively measured, can be influenced by your actions, and that are sufficiently within your scope of control.  Not only must good metrics be selected, appropriate numerical targets need to be set that reflect the “goal weighting” priorities as well as safety limits, federal requirements, and other parameters.

And third is figuring out how to model the ways and degrees that different types and amounts of investment will change operations, and that each of those operational changes will impact the metrics.  While nationally-accepted formulas already exist for translating road budgets into road improvements and then into increased car mobility (meaning greater speed and volume with fewer delays), doing the same for other modes – transit, bicycling, walking – is a still-evolving practice.  (Equally important, and also lacking in predictive tools, is exploring ways to restructure operations and infrastructure to move the metrics without major investment!)

In each category, the way a goal is defined shapes the way it is measured and the actions ultimately taken to achieve it.  For example, MassDOT’s Planning for Performance tool’s definition of “mobility” as “the number of hours of delay experienced by the average driver for every 1,000 Vehicle-Miles-Traveled”  not only ignores anything related to non-car travel, it also skews the measurement towards Single Occupancy Vehicles since it only counts delays to a driver rather than to all vehicle occupants.

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GETTING MORE EGGS FROM THE GOLDEN GOOSE: “Nobody in this Country got Rich on their Own.”

February 11, 2014

It takes resources to run a city. Of course, the most important resource is people: the capabilities and creativity of its work force, the strength and resiliency of its families and neighborhoods, the civic engagement of its residents – and if Mayor Walsh is really smart he will find many ways to encourage city volunteerism in every segment of government and social life.

But money also counts.  Transportation, parks, social services, fire, police, housing, schools, and everything else: all cost money – inescapably (and legitimately) more today than yesterday, more tomorrow than today.  State law makes cities’ revenue overwhelmingly dependent on property taxes; they provide about two-thirds of Boston’s operating budget.  And (in Massachusetts) the Prop. 2½ limits on increasing the rates on pre-1982 buildings make local governments desperate for new development, particularly commercial development which has higher tax rates than residential buildings.  (The Boston Business Journal complains that “commercial properties downtown, in the Back Bay, and the Seaport… are taxed at nearly three times the residential rate …and generate more than half of Boston’s total tax levy….”)


In the absence of other sources of revenue, new development provides the budget space for public needs.  But growth has its own costs, from gentrification to traffic congestion.  A recent study of major US cities found that nearly 61% of Boston’s low-priced neighborhoods were affected by gentrification – the highest percentage in the nation.

Conservatives always warn against “killing the goose that lays the golden eggs” and it is possible for a city to make it so difficult for developers to operate that they go elsewhere.  But we (and our leaders) need to humbly remember that local action has only secondary influence on the most significant economic tides.  It’s exactly when business is growing that it is most possible to require that they contribute a bit more to the health of the surrounding society that allows them to exist and prosper.  And a city totally transformed by development may lose the qualities that made it attractive in the first place.  Even more:  we need to remember that the real “makers” of our well-being are the population as a whole, with every sector playing an indispensable role.  Business leaders deserve to be rewarded for their accomplishments and risk, but only to the degree that their effort increases overall wellbeing as well as their own.


Rather than endangering business growth, the bigger danger is that city leaders are too timid, not imaginative enough, and therefore unable to harness business energy for the common good.  It turns out that rising tides don’t lift all boats – a better metaphor is trying to lift a house:  pulling on the roof only raises the top floor; you have to raise it from the foundation if you want to elevate every room.  In any case, the current development tide will eventually ebb, as business booms always do, leaving a lot less to be shared and making it much harder to demand additional concessions.  Now is the time!

The best approaches are those that integrate a broader range of public benefits into the businesses’ every-day operations:  inclusionary zoning, job training and hiring preferences.  It is also easy to make a case for requiring the developer to make improvements to the surrounding environment through mitigation fees or requiring that they upgrade nearby parks, roads, or other public facilities. (Why not require new developments to also construct some nearby portion of the city’s Bicycle Network, or a section of the Greenway Network that advocates are beginning to work for?)   Less obvious but equally appropriate are the linkages – housing linkage, for example – that require payment into a fund for use city-wide.  (Boston would also be smart to adopt the Community Preservation Act that imposes a surcharge on every property sale.)

Mayor Walsh is faced with an immediate budget crisis, potentially requiring short-term cuts, ultimately because of limits on the city’s revenue sources and amounts but immediately due to political unwillingness to rein-in police and firefighter pay raises.  But Boston currently ranks fourth nationally in the amount of commercial space under construction.  A “surge of wealth has flooded Boston in recent years…[and] muchof the new housing is made up of high end residences, with many apartments renting for $4,000 or more per month….Boston was among the top 30 [cities] with the highest projected demand for luxury goods over the next five years.”  In the long term, the growth and money is there and advocates should not be shy about pushing the Mayor to keep squeezing the development goose.

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January 16, 2014

Techno-utopians.  It wasn’t long ago that we were being told that digital Information and Communication Technologies would solve nearly every problem and transform the world in wonderful ways, small and big.  Cars would be routed around congestion; government would more accurately chart population needs. Although there were some efforts to broaden the scope of “smart” to include people as well as systems, the vision was primarily about technology.

Most of us now understand that the promised land of technology-enabled paradise isn’t going to happen, or at least that change – even transformation – is not the same as progress, that making things faster or more efficient or more connected or more data-rich is not the same as improving the quality of life.  In fact, we’ve seen numerous ways in which digital technologies –when they actually work – have made things worse, or at least simply recreated existing hierarchies, inequalities, and problems.  And there are good reasons to worry that the pursuit of “big data” capabilities will be even more dangerous – as low-income recipients of social services often already experience.

The push for Smart Cities drew much of its original energy from the techno-utopian well.  It was popularized by multi-national technology firms seeking new markets.  If we’re lucky, the wave of big ideas has crested and we’ve moved into an era of more modest, decentralized, and do-able – one good example being Boston’s own “New Urban Mechanics” program.

Technology is just a tool.  And selecting the appropriate tool, an appropriate technology, requires first deciding what you are trying to use it for – not just the immediate task but the deeper social and political conditions.  Good technology is developed or adopted in order to strengthen core values:  democracy, community, equality, individual dignity.  Quality of life, in transportation and everything else, results from the successful cultivation of these qualities.  Continue Reading »


January 7, 2014

We’ve all seen the graph: a person hit by a car going 40 miles per hour (mph) has an 85% chance of being killed.  Reducing the speed to 30 mph cuts the odds of death in half; reducing speed to 20 mph drops the fatality rate by an astounding 94%.  Even more dramatically, at 5 mph cars (and very cautious trucks), bikes, and pedestrians can all safely share the same street space.  According to the US Department of Transportation, about 33% of vehicle-related deaths are speeding-related.  Of those, around 40% occur in urban areas.

Almost every neighborhood feels that too many cars (and trucks) are driving through too fast making too much noise and endangering everyone.   One impact is to severely limit the number of people who are willing to walk, bike, or even hang around outside with their neighbors.   Especially affected:  the elderly, the infirm, the very young, the slow moving.  Especially impaired:  public health, social connectivity, local businesses, and (because it is almost always worse in low-income communities) social equity.

The most effective way to slow traffic is through physical changes in the road and its surroundings.  But despite progressive policy statements at the state and federal levels about the need to promote walking, bicycling, and transit as much as – or even more than – car traffic, current planning and operational procedures and practices continue to generally lead to car-centric results.   Changing this requires elevating the concept of “desired” or “target” speed to a central place in all road transportation analyses and decisions, while broadening its interpretation to incorporate criteria relating to the promotion of non-car modes.  As a step towards that goal, we also need to support two bills currently in the Massachusetts Legislature that would allow the local creation of additional 20 mph Safety Zones and reduce the Legislatively-set Statutory (default) speed limits on streets without Posted Limits.

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January 3, 2014

Solstice.  New Years.    The annual Janus; looking both forward and backward at another year of transitions and challenges.

As we look out our windows at the energized serenity of fresh snow, hope for both personal and societal peace and progress grows anew.  Like so many of you, I spend a lot of time and energy working for positive change small and large, short- and long-term, internal and external.  Sometimes it feels like slush.

I still think that there are deep patterns and drives to human life, from individual personality development to social evolution.  I believe even more than ever that the larger context shapes whatever lies within it, that wealth and power have and will always do whatever it must to retain its status, that many people do many horrible things, and that creating a good life, both at home and in the world, requires individual and collective action.

However, I no longer believe, as I once did, that history is inherently on our side — that the universe, as Martin Luther King prophesied, “bends towards justice.”   Bad things happen. I’ve come to appreciate the importance of individual difference, the unpredictability of events, and the great unlikelihood that things turn out the way we want.  The future, of those we love and the world we live in, is always up for grabs and there is no inevitability that a lot of that future won’t be, like so much of the past, painful and destructive.

The contingency of politics and life-affirming change both adds to our individual responsibility and eases the potential guilt.  And it reminds us that the scope of our lives is more inclusive than our public role.

So, as you do what do you, enjoy life.  Eat well, and in good company. Support yourself, but hold hands with others.  Give and accept hugs, and love.  Take care of yourself and someone else.  Remember that happiness and sadness, pleasure and pain, and all the other opposing pairs are actually composed of separate realities – the fact that you are now sad does not cancel out previous happiness: this, too, shall pass.  Walk, bike, and play more.  As you head for the horizon make sure to pay attention to what’s directly underfoot.

I have learned that while we can’t save the world, we can be friends.

I hope for a healthy, happy, and satisfying year to all of you, to us all.  Be well!

LIVABILITY, PUBLIC HEALTH, AND MOVING AROUND: A Healthy Society Requires Healthy People

December 2, 2013

Boston Public Health Commissioner, Barbara Ferrer, says that while Boston has many Public Health needs, the three biggest challenges facing the city are reducing violence, making a positive health impact an explicit goal of every policy in every department, and using the new provisions of the Patient Protection and Affordable Care Act to get hospitals and other health-care providers to do more about prevention.

Although she probably would not object to adding obesity (with its tight connection to poor food, inadequate physical activity, and too much TV) and greater equity to the list, Commissioner Ferrer’s three challenges begin to frame a Public Health approach to livability.  Safety, at home and on the street, is the prerequisite for nearly everything from personal wellbeing to neighborhood life to economic prosperity.  Our health is not a separate phenomenon from everything else in our lives – our homes, neighborhoods, transportation methods, jobs, recreation, family and social life have a powerful effect on our well-being:  policy makers dealing with any other those areas have to make health impact a visible consideration. No public agency or department should be allowed to narrow their focus in ways that externalize burdens and costs – every program has to include a broad range of goals.  And we have to start forcing our health care system – the most technologically advance, most expensive, and least cost-effective in terms of population wellbeing of any industrialized nation in history – to pivot from prioritizing medicalized sickness treatment to helping keep people from getting sick in the first place.

Public Health is not just about living longer, but living better; not only about meeting basic needs, but the quality of people’s interactions; not just about individual health, but about population-societal well-being and equity. In this era of political polarization and cultural anxiety, Public Health provides powerful strategic insights for a variety of public issues.   So it’s probably no accident that MassDOT’s latest advance towards transportation reform is titled the “Healthy Transportation Policy Directive.”  It’s not just that Secretary Davey is using words required by the 2009 Transportation Reform Act, and it’s not that economics aren’t the most powerful underlying driver of politics.  Just the opposite: it’s that he recognizes that for transportation – as for a huge number of other sectors – having access to basic daily needs such as jobs, healthcare, food and school is a catalyst for being healthy and is a critical part of the path to economic development with a high return on investment.

But too often, invoking health is a marketing ploy, not a programmatic or policy direction. Some of the misappropriation of the term is deliberate.  Some of it comes from the confusion between Medicine’s focus (at least in our cultural image) on dramatic and quick results – the “magic pill” we all wish would solve our every problem – and Public Health’s focus on longer-term solutions and population wellness within its three themes of Prevent, Promote, Protect.  Related to this is that most of us have little understanding of what Public Health encompasses.  Rather than Medicine’s traditional focus on individualized treatment, Public Health is about maintaining wellness – prevention – and it focuses on interventions that increase resilience and reduce exposure to health risks for an entire population.  Public health is not just about improving our overall health statistics, but also about the distribution of that improvement through every sector of society.

Public Health can be thought of as having three major components:  Preventive Medicine, Standards Enforcement, and Primary Prevention, all in a context of reducing outcome disparities between subgroups.  Preventive Medicine, such vaccinations and  helping patients continue taking prescribed drugs, is what hospitals and other health service providers are beginning to do, but need to be forced to do more. Standards Enforcement, such as restaurant and housing code inspections, is one of the functions of government that we have to make sure declining budgets don’t cut into ineffectiveness.  But Primary Prevention is the most fundamental, powerful, and difficult.

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